| Name: | Affinity Physician Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 30 Aug 2005 (19 years ago) |
| Entity Number: | 000-609-101 |
| Register Number: | 000609101 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 5800 TENNYSON PARKWAYPLANO, TX 75024 |
| Principal Mailing Address: | 600 MADISON AVENUE 8TH FLOORNEW YORK, NY 10022 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
HEALTH CARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710661293 | 2023-06-14 | 2023-06-14 | PO BOX 689022, FRANKLIN, TN, 370689022, US | 2556 HELENA RD STE C-1, HELENA, AL, 350803260, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 615-465-7429 |
| Fax | 6156286877 |
| Phone | +1 205-685-4870 |
| Fax | 2059713574 |
Authorized person
| Name | JENNIFER L JACKSON |
| Role | SNR DIRECTOR PROVIDER ENROLLMENT |
| Phone | 6154653334 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
